CMS officials are urging physicians and teaching hospitals to prepare for implementation of a national program(www.cms.gov) that requires drug and device manufacturers and group purchasing organizations (GPOs) to report payments or gifts of $10 or more made to physicians, hospitals and other providers on a yearly basis.
In a May 22 provider call(cms.gov), Anita Griner, M.B.A., deputy director of the Data Sharing and Partnership Group at the CMS Center for Program Integrity, stressed that although physicians and teaching hospitals are not required to register for the National Physician Payment Transparency Program, registering would allow them to review the reported data before it is posted on a public website next year.
Moreover, said Griner, physicians and teaching hospitals that register for the program will have an opportunity to dispute inaccurate or incomplete information and have it corrected before it is posted.
Physicians and teaching hospitals will be able to register for the program in early 2014.
"We will not be allowing for bulk registration, so a group practice cannot come in and register their entire practice," Griner noted during the call. "Each physician will come in and register (individually)."
- CMS held a provider call on May 22 that outlined various provisions of the National Physician Payment Transparency Program, including how physicians can prepare for the program's launch.
- CMS officials encouraged physicians to voluntarily register for the program so they can review and correct data about gifts and other transfers of value before the data are posted publicly.
- CMS officials also identified the entities and types of value transfers that are covered by the program.
The National Physician Payment Transparency Program, also known as the Physician Payments Sunshine Act, was passed as part of the health care reform law and is designed to create greater transparency among physicians, teaching hospitals, GPOs, and drug and device manufacturers. The law also requires drug and device manufacturers and GPOs to report ownership and investment interests held by physicians or their immediate family members in these entities.
CMS is requiring manufacturers and GPOs to start collecting data on Aug. 1 and submit data collected between Aug. 1 and the end of the year to CMS by March 31, 2014. CMS will provide an initial 45-day period during which physicians and teaching hospitals can review and dispute any data they consider inaccurate. If the dispute can be resolved in that 45-day window, then the corrected information will appear on the website when it launches.
That will be followed by a 15-day period to allow for further review of data and to give physicians and teaching hospitals more time to resolve outstanding disputes with manufacturers and GPOs. Physicians and teaching hospitals may continue to initiate disputes during this period, but resolutions may not be reflected in the data that are publicly displayed.
"Disputed data still will be made public," Griner explained. "It will be marked as disputed.
"Any corrections that are made to the data by applicable manufacturers and reattested (to CMS) then will override that original dispute, and will not be marked as disputed on the public website."
During the first year of the program, CMS will post five months of data on Sept. 30, 2014, and in subsequent years, the agency will post a year's worth of data annually on June 30.
"In a normal year, there will be a year of data collection (from) Jan. 1 through Dec. 31," said Griner.
During the call, CMS officials identified which entities are covered by the law and how payments and transfers of value will be handled. For example, manufacturers and GPOs are required to report payments or other transfers of value of $10 or more made to all physicians regardless of whether the physician participates in the Medicare and Medicaid programs. The rule also pertains to teaching hospitals that receive Medicare payments. However, medical residents and physicians who are employees of the applicable manufacturer are excluded from the reporting requirements.
Regarding ownership and investment interests held by physicians or their immediate family members in GPOs or manufacturing companies, the rule pertains to stock, stock options, partnership shares, loans, and bonds or other financial instruments that are secured with an entity's property.
In addition, the rule covers indirect payments -- that is, payments that come from manufacturers and GPOs to teaching hospitals or physicians through an intermediary, such as a specialty society or research organization.
CMS officials cited examples of reportable value transfers during the call, such as consulting fees, honoraria, gifts, entertainment, food and beverages, travel and lodging, and grants. They also described value transfers that are not reportable, such as product samples for patients' use, in-kind items used for charity care and transfers of value to nonphysicians.
One example many family physicians may recognize would involve a drug representative who comes to a physician's office to discuss a new medication while providing lunch for the physician. If the lunch costs $10 or more, it is reportable. If the drug representative leaves samples of the medication that are intended for distribution to patients, those samples are excluded from the reporting requirements.
To become more familiar with the program and its requirements, CMS is encouraging physicians and teaching hospitals to take the following steps:
- learn what information about physicians and teaching hospitals is reported;
- keep records of all payments and other transfers of value received from manufacturers;
- register with CMS and subscribe to the agency's electronic mailing list(public.govdelivery.com) -- selecting the "OpenPayments" option under the "Regulations & Guidance" topic heading -- to receive updates about the program;
- review the information manufacturers have submitted when it becomes available; and
- work with applicable manufacturers to ensure the information reported is correct.
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